The Problem of Nursing Stress


Nurse shortage has been documented as one of the factors that lead to increased medication errors and the inability to provide quality care to patients due to its capacity to generate burnout and stress among nursing professionals (Wittenberg-Lyles, Goldsmith, & Reno, 2014). As such, there is a need to develop and implement interventions aimed at reducing stress among nurses working for long shift hours due to the shortage of professionals in healthcare settings.

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This paper critiques a qualitative research article with the view to developing evidence-based nursing knowledge on how such interventions are able to address the problem of nursing stress, which in turn reduces medication errors and improves patient care outcomes. The article is by Karadzinska-Bishmovska et al. (2014), and is titled “Linkages between Workplace Stressors and Quality of Care from Health Professionals’ Perspective – A Macedonian Experience.”

Background of the Study

The clinical problem is anchored on identifying workplace stressors and psychosocial risks that originate from workplace conditions and workplace demands to affect how health care professionals are able to provide quality care to patients. There was a research gap on how similar and overlapping workplace factors in practice environments generate stress and burnout in health care professionals and adversely affect their capacity to provide quality care to patients (Karadzinska-Bishmovska et al., 2014).

Additionally, the authors were unsure of what interventions and strategies could be used to prevent job-related stress among health care professionals as well as enhance organizational culture and climate in practice settings. In establishing the significance of the study, Karadzinska-Bishmovska et al. (2014) reinforced the importance of dealing with the issue of workplace stress due to its capacity to trigger negative outcomes, such as increased absenteeism, decreased job commitment and motivation, increased staff turnover, impairment of performance and quality of care, increased unsafe working practices, increased medication errors and other accidents, and increased complaints from patients and other stakeholders in the health sector.

The main purpose of the research study was embedded in identifying workplace stressors and factors that affect the quality of care from health professionals’ perspective and to identify the associations between these stressors and the delivery of poor quality care (Karadzinska-Bishmovska et al., 2014). A secondary objective was to explore the effectiveness of intervention programs for stress and burnout in reducing accidents and improving the quality of care provided to patients.

The authors did not include a research question in their study; however, the implied research question could be as follows: What are the individual and organizational factors that affect the quality of care provided to patients and compromise their safety? Another implied research question is as follows: What are some of the most important bottom-up interventions that could be used in practice settings to minimize nursing stress and hence increase the quality of care provided to patients and the wellbeing of health care professionals? It is important to note that the main objective of the research study was directly related to the research problem.

Methods of Study

The authors used a qualitative research approach and a focus group (FG) methodology to undertake the study, which was effective as they allowed them to develop an in-depth understanding of the issues of interest from the perspective of health care professionals. The FG methodology can be termed as the specific perspective from which the study was developed since it influenced how data collection and analysis were conducted by the researchers. Overall, this perspective not only facilitated the researchers to put together the pieces of the research process resulting in the research study but also allowed for assurance that the evidence adduced had practicality (Bosewell & Cannon, 2012).

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The authors used primary quantitative and qualitative studies relevant to the focus of the study, in addition to credible books, policy documents, and other sources of secondary literature. It is important to note that most of the references used in the study were up-to-date, though the authors made use of several older publications that appeared to have seminal information about the issues of interest. Although the literature review was well organized and made use of benchmark publications as proposed by Bosewell and Cannon (2012), the authors nevertheless failed to evaluate the weaknesses of the reviewed studies.

Overall, however, Karadzinska-Bishmovska et al. (2014) were able to synthesize important information from the sources and include it in developing a logical argument based on the stated research objectives. Although the researchers used a focus group methodology rather than grounded theory, two diagrams were developed from the study findings to describe the workplace factors that lead to stress and the factors that influence the quality of care in practice settings.

Results of Study

Health care professionals said that the individual and organizational factors that affected the quality of care provided to patients and compromised their safety included lack of adequate staff members, prolonged working hours due to nurse shortage, work overload, the elevated pace of work, high job demands, providing care to large numbers of patients, lack of equipment, lack of supplies and medications, lack of training, few opportunities for professional development, and low salaries (Karadzinska-Bishmovska et al., 2014).

The sampled health care professionals exhibited optimism that the issues occasioned by job-related stress could be effectively addressed by enhancing job satisfaction, putting in place focused stress-reduction interventions, ensuring the presence of supportive interpersonal relationships, and engendering professionals to participate in decision making and teamwork. In terms of implications, it is evident that these results can be applied in clinical settings to reduce job-related stress, hence effectively addressing the issues of medication errors and the provision of low-quality care.

The findings contribute to nursing knowledge not only by showing the association between these stressors and adverse healthcare outcomes such as increased accidents and low-quality care delivery but also by underlining what needs to be done to address the stressors. This knowledge is bound to impact clinical practice by virtue of reducing medication errors and enhancing the quality of care provided to patients.

Ethical Considerations

The study was approved by the ethical committee of the hospital which served as the study context; however, the authors did not provide any information to show how the privacy and confidentiality of participants were safeguarded. Although the subjects were fully informed about the nature and purpose of the research, it was important for the researchers to demonstrate how ethical considerations regarding the confidentiality and anonymity of responses provided by participants during the data collection exercise were guaranteed.


This paper has critiqued a qualitative research article with the view to showing that stress-reduction interventions have the capacity to reduce medication errors and improve patient care outcomes in practice settings. The critiqued paper illuminates the association between individual/organizational stressors and adverse health outcomes witnessed in practice settings. It is clear from the critiqued article that implementing focused organizational intervention programs and strategies can result in the prevention of work-related stress, which in turn reduces medical accidents and improves the quality of care provided to patients. This evidence-based nursing knowledge can be applied in actual practice settings to minimize adverse health outcomes fuelled by stress-related factors.

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Bosewell, C., & Cannon, S. (2012). Introduction to nursing research: Incorporating evidence based practice. Burlington, MA: Jones & Bartlett Learning.

Karadzinska-Bishmovska, J., Basarovska, V., Mijakoski, D., Minov, J., Stoleski, S., Angeleska, N., & Atanasovska, A. (2014). Linkages between workplace stressors and quality of care from health professionals’ perspective – A Macedonian experience. British Journal of Health Psychology, 19(1), 425-441. doi: 10.1111/bjhp.12040.

Wittenberg-Lyles, E., Goldsmith, J., & Reno, J. (2014). Perceived benefits and challenges of an oncology nurse support group. Clinical Journal of Oncology Nursing, 18(4), E71-E78. doi: 10.1188/14.CJON.E71-E76.

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